Cyproheptadine (or periactin) to Boost Appetite

Question: I was searching your site for more information about the use of cyproheptadine as an appetite stimulant. I recently had an evaluation with a kiddo who is taking this twice a day to increase appetite but mom doesn’t think it has helped much. Wondering what your team does for dosage? I have had some experience working with periactin and I remember that it was usually best to be on it for a period and then off again. Does cyproheptadine work the same way?

Answer:

Cypropheptadine (or periactin) is an antihistamine (similar to benadryl), which frequently has the side effects of increase in hunger. Typically this medication is used only after a child is very comfortable having no symptoms of reflux ( such as vomiting, gagging, choking), as well has constipation managed ( stooling 1-2 times per day pudding like stools). It is started to help jump start a child’s appetite. Often if a children’s GI symptoms are not medically managed there is not much benefit seen from the periactin.

The biggest side effects you see are sleepiness, and irritability. To help counteract this it is typically started once a day at bedtime. If the child does well with this after 3-7 days it is then increased up to twice per day. If the child is too sleepy, or irritable then it is reduced down to once per day. This medication typically works well for around 6-8 weeks and then the effectiveness wears off. For this reason it is often stopped x 3-4 days, and then restarted. At times to maintain effectiveness it is done 5 days on and 2 days off.

Victoria Powell RN, MSN, CPNP

Pediatric Gastroenterology Clinic

UNC Children’s Hospital

I have been wanting to post on the benefits of using an appetite stimulant (from the perspective of a feeding therapist) for some time now. I was reminded when I received this question from a reader.

Our feeding team uses many different medical management strategies to help kids feel more comfortable and eventually eat better. One of the the medicines we use is periactin to boost appetite. Tori explained how we use it but I will add that in addition to the hunger benefit, we feel it may also have a motility effect. We have some families report that their children have reduced vomiting while taking the medicine.

Like all medicines we use, it does not work for everyone, however, for some children we can see real benefit from it. Parents sometimes report that their children are asking for food for the first time or ask for more volume at meals. We combined the medical management (and nutritional) strategies with feeding therapy to get the best and most lasting effect. We also tend to see that over time as eating becomes easier, the children need this medicine less. They do not become dependent on it.

I specifically asked Tori not to provide dosing information here on the blog. If you have questions about periactin or are using it with your feeding patients please write in. If you are interested in trying it with your clients, talk with your medical team or referring physician about it.

I want to reiterate what Tori said above about making sure the child is comfortable from a GI perspective before adding the appetite stimulant. We have seen children that were given the periactin while still uncomfortable or were started on the medicine multiple times a day and became very sleepy. In both cases, parents were unhappy with the results.

However, if used correctly and the child responds it can have very positive outcomes. Typically, we start our feeding patients with gastroesophageal reflux and constipation management as well as nutritional management for caloric and nutrients needs and formula tolerance. A month later, at the second feeding team appointment is when, depending on symptoms, a child may be considered for a motility medicine or appetite stimulant. The time a child may take the periactin varies by case but most of kids use it for several months combined with feeding therapy. As eating becomes easier, and the dramatic effects of the medicine lessen, the periatin is cycled and then at some point stopped under the guidance of the GI nurse practitioners.

As a feeding therapist, I might also request a trial of periactin. Especially if I am working with a child who is having difficulty tolerating appropriate amounts of food, or who has poor hunger cues, or a long history of poor intake.

Case:

I am working with a patient now who has been struggling with intake. I have seen her a few times and have gotten her to eat 2-3 oz of puree in behavioral feeding therapy with frequent refusals and aversive behaviors. After periactin was started, the child came to therapy and I asked her Father if had noticed a difference. He said he had noticed a small difference and that she was asking to eat foods she used to eat and did seem to be eating bigger amounts. That day in therapy she accepted 10 ounces of puree easily! 2 flavors were familiar but she also accepted 2 oz of a totally new food without any refusals. I definitely saw a difference in this child. Now, we will build on this new acceptance to expand her diet and maintain age appropriate volumes of foods.

never heard of Cypropheptadine. am glad to know that it is an antihistamine (similar to benadryl), which frequently has the side effects of increase in hunger.should talk to my pediatrician on the same.thanks for sharing

My son has been on and off of this medication and it clearly has no effect on his appetite. He is severely underweight and has no natural appetite (quit self feeding at ten days and went on a feeding tube). What’s the next step?

My daughter had a primary complex and was treated for 10 months. She’s turning 2 years old this August and weighs 9kgs. I tried lots of vitamins as prescribed by her pediatrician still didn’t work. On Monday we have a follow up check up and will ask this periactin to her pedia. But I think this med is not available here in our country (Philippines).

My 6 year old just started Periactin twice daily. She’s underweight., a struggle for 5 years now though we did make good momentum upward between ages 3.5 and 5 but dropped back to 13 percentile. We had a lengthy discussion with the G.I. but I’m not for remembering or maybe understanding but we’re essentially using this along with Nexium twice today to see if it’s possible for her to gain the weight comfortably before jumping to scope her to look for something like EOE. Allergy, stool and thyroid labs were all normal as a toddler.
We’re only on day 3 of 2.5mg BID and I’m definitely not noticing an appetite change yet. I see “irritability” is mentioned above, would mood swings sound right st this age? She’s a very emotional child but overwhelmingly well-behaved and usually only has trouble coping with little things without an emotional outburst if she is overly tired which I don’t believe she has this week. The medication does not seem to make her sleepy in the waste however unless it is going today and then about 30 to 45 minutes after each does she have had a major breakdown of frustration over something very small. One time it was because it was 30° out and I made her wear a winter coat that she said made her look ugly then last night as another example is playing with make up before that and thought she made her eyebrows look ugly so she had a big meltdown. Two minutes later though she can be absolutely fine but then she got cold in the bathtub and was a mess crying to get out of the bath. So an emotional rollercoaster!! Does this sound typical of the drug or likely coincidence? Her G.I. doctor wanted to start with a smaller dose so doesn’t make her sleepy. Is this does too small to even be affective as it does not seem to be increasing appetite in fact she weighed last night had a half a pound less than the average she has been for the last three or four days. She hasn’t joyed seeing her progress in the last two months so she chooses to get on the scale most nightS.
And I realize as a pediatric nurse that this is all very complicated but I appreciate any insight. I definitely see with the pound and a half that she has gain since the end of September she looks healthier and I believe she needs to gain another pound or two but I also see her next to her peers and sometimes it is hard to believe all of the Pediatrician in G.I. doctors worries. I worry that she seems to need reflux medicine and I worry when she seems to eat less than the one-year-old me babysit but she is the youngest in her class by up to a year and is the same height as all the other children and even the same exact weight as a few of her good friends. She has a normal stool once every day and she sleeps well and is entering a gifted program. She has never had any swallowing issues ever outside of maybe a week this summer when she said it felt funny when she was swallowing but that resolved on its own. She also has no serious aversions by the definition that I know.

Update: this drug has its challenges ( like emotions at times!) but now we can do even just 3cc once daily or even every other day and she’s gained 6 pounds since September. Looks healthier and can wear clothing better! She’s on the growth chart again and our main concern was her vertical growth stopping from age 5-6. Now going on 7 she is as tall as her peers and almost a full year younger. She has grown like a weed since December. The behavior and emotional roller coaster weren’t an issue with small doses twice daily after a few weeks. It’s more now that I’ve drastically reduced the amount and frequency since her weight is currently small but healthy. Double edged sword.
But she’s FAR more willing to try foods and consumes drastically more when on the Med.

Hi
I am Zulay and i have been reading your page.
You see….I have a granddaughter that is 2 years old.
She has continually colds and even without having colds her apetite is gone.

I remember my sister was the same way. My mother gave her Periactin and it helped her.
This was ofcourse decades ago and when we were living in Venezuela.
We are now in Holland and the doctors here don”t believe in medicine and they”re not helping my granddaughter at all.
My daughter is broken and can’t stop crying.
The baby”s weight is 10kg that is more or less than 20 lbs and that is just too little for a girl of 2 years and 5 months old.
She has no sickness or vomid or diarrea….nothing like that.
Only colds. Teething and she just hates food.

Please help me.
I wanted to buy the periactin and give it too her myself.
But a little service first is better.
I really hope to hear from you soon.
My daughter is desparate.

Wow. I’m so sorry. I’m not a doctor here but the psychology of feeding little ones is so strong I wonder if since you say she “hates food” she has actually created some aversions . We had great success with the Ellyn Satter DOR methods when my daughter was ages two until four. Our pediatrician and G.I. doctors as well as all of the nutritionist I work with all believe in her methods. When my same daughter got older though she just has a natural tendency towards liking healthier foods and junk food like potato chips but nothing in between. With her tiny appetite she stopped growing vertically and that’s when they got worried. Periactin was a rough start with a lot of emotional highs and lows and if we take the drug holidays where we stop at for a week every few weeks as recommended we have the emotions all over again so I just don’t stop . It has worked wonders for us though and she has put on almost 5 pounds in about five months. She legitimately eat a lot of garbage but the doctors say that calories are more important for her right now then even nutrition. But for example now instead of a tiny bowl of cereal she will eat two or three toaster strudels which give her 4 to 600 cal before school . Yes there is a lot of sugar in there as well but at this point everybody is just happy that she’s growing and when her stomach is stretched and used to eating the same amount of food as normal children then we will probably be able to go off of medication and even now we are getting more of those healthy foods and it’s just that they have no calories. The liquid coconut cooking oil that is flavorless and stays liquid at room temperature has been a godsend for us because I can mix 130 extra calories with just 1 tablespoon into a tiny bit of yogurt and she has no idea. Milkshakes do not work because she does not like them unless they are the ice cream type and Pediasure has too much protein so she gets too full and won’t eat anything else. .
Anywhere I feel for you because it is such a struggle and I wish her doctors would help you saying that you were willing to try anything but honestly I wonder if your next step should be to take her to a nutritionist that specializes in pediatrics and from there she could recommend whether she thinks a feeding therapy or appetite stimulant could be beneficial. The other thing to consider since you mentioned that she has chronic colds is could she have something like a sinus infection that is rendering her no taste ? Or could there be anything else going on that is making her have zero desire to eat ? Like will she eat garbage if she is allowed or does she not even want that ? Our beloved G.I. doctor literally prescribed our family a dinner or lunch at the local pizza buffet that my daughter states is her favorite restaurant once a week or more. It’s fantastic now on the Periactin to see her go to her favorite restaurant and eat an entire plate full of food . We were on vacation last week and a few days we even skip the dose of Periactin and she still ate well. She has more energy and she was happier when she has enough calories to carry through her day!
I wish you the best of luck and keep advocating for your granddaughter. I am a pediatric nurse and a mom and I know that children grow at all different rates and some are just small So long as they stay on their growth curve!! It’s when the growth stops that’s we worry.

what a wonderful reply, packed full of nuggets of great information and positive advice.
Thanks for sharing.
I work with kids on behavioral medications, and this is quite helpful, filled with practical advice and suggestions I will share with them.

My bother who had a stroke in February 2017. Stopped eating about two months ago, he says he doesn’t want to eat, has no taste for food.. He smokes constantly, has lost so much weigh. Do you think Cyproheptadine will help him?.?

i am in hyderabad my child is 7 years old bus he is thin he was not eating food . weight is onl 14 kg please send me cyproheptadine syrup/powder name i search but hyderabad in not available . medical store

Honestly I don’t want mine dependent on meds either so we used it to get her up to a somewhat healthier weight and interested in eating again and stopped daily use. I really hope your MD amd GI are involved as yours is very little and should have a good appetite naturally. Or st least the desire to eat even if little. Don’t be afraid to ask for help. These early years set up their earing attitudes for a long time. Ellen Satter DOR helped us a lot at age 4 then it didn’t when an allergic toddler and traveling spouse at the time changed our cooking and eating routines. Great books. Highly recommended by nutritionists and specialists.
Now we use periactin sporadically. Three milliliters (3cc) once daily or every other day or even less frequently when it seems we arent eating even like a bird. It makes a drastic difference for us. She is slightly more willing to try things as well. A child who quits eating altogether or has no interest in eating beyond an illness in my book needs an MD or GI appointment asap, but you have already been for the problem. Our GI used a PPI and periactin as a little test before going a scope. His thought was if she starts eating more, it’s likely a hunger ( lack of) problem over a disorder like EOE. Then I did a lot of high calorie foods -some were awful like Cheetos , weekly pizza buffet, coconut cooking oil in everything and toaster strudels. She stopped growing so MD, GI, and nutrition said to get her eating first and calories in and work on nutrition later. We needed it, might not be for everyone.
Good luck with your sweet one!!! It’s so hard !

I have been taking periactin for about two weeks now, I am 17 and have struggled with appetite issues for years. This is the only thing that gives me motive to eat but on days I don’t take it I again don’t want to eat. Does this mean I will only get the appetite benefits while on it? I have finally gained some weight and don’t want to continue gaining weight if I’m going to lose it all again as soon as I’m dome taking it

My child does not have appetite we struggle when it is meal time, as a result her wait has droped and also her stool is always hard as she is constipated all the time. Can you advice me with anything that i can use because it is worrying me.